Mental institutions

Parrot cage from Sussex Lunatic Asylum, Europe, 1859-1939

Large Victorian public asylums haunt the history of psychiatry. They were hailed as places of refuge for some of society’s supposedly most vulnerable men and women. These buildings were called ‘lunatic asylums’, and later renamed ‘mental hospitals’. They earned a reputation as dehumanising, prison-like institutions.

Home-based or church-based care

Before asylums,the burden of keeping vulnerable individuals rested almost entirely on loved ones. ‘Mad’ people who could not be kept at home wandered free, begging for food and shelter, and often - like Shakespeare’s Lear or Ophelia - finding none

In Europe a few small Christian institutions dedicated to sheltering the insane emerged in the early Middle Ages. London’s Bedlam was the most famous. It did not hold more than two dozen inmates until the 1620s.

Private ‘madhouses’ to public asylums

A growing market economy in the 1600s and 1700s saw ‘service professions’ emerge. Those who worked in them did thankless jobs formerly handled at home or by the church, and included undertakers, private tutors and ‘madhouse - keepers’. Families paid for secrecy and discretion, and private ‘madhouses’ left few records. Artefacts show keepers used physical restraints such as leg-irons and manacles. Some keepers adopted ‘management’ techniques developed by Renaissance horse - masters to control stubborn horses.

Quaker businessman William Tuke founded the York Retreat in the 1790s. It was the first asylum to shun physical restraint and coercion. Its influential methods became known as moral treatment, which relied on constant surveillance. Around the same time physician Philippe Pinel famously unchained mental patients in Paris asylums, declaring they were sick, not criminals. This story is more legend than fact. Nevertheless, Pinel was a hero among asylum reformers and promoters in the golden age of asylums that followed.

Public funding poured into asylum construction between 1800 and 1900. Advocates for building asylums included Dorothea Dix. Like many Victorians, they placed faith in bricks-and-mortar solutions to social problems associated with the accelerating pace of modern life. The patient population in England went from about 10,000 to 10 times that. Asylums built in this period impressed public officials, as the buildings were designed to be majestic and therapeutic. Extraordinary attention was paid to ventilation and to safety, and most asylums also featured extensive grounds - beautiful gardens were tended by patients as part of their treatment.

Medical expertise

Psychiatrists combined Tuke’s and Pinel’s methods to manage patients. They created a medical version of moral treatment reliant on the secular moral authority of the (always-male) psychiatrist, who controlled asylum life. The theory was that a carefully designed and regulated environment, with a strong father figure, calmed patients and restored their sanity.

Asylum physicians’ exaggerated claims of curing ‘lunacy’ by moral treatment backfired. Expensive but inflexible buildings became overcrowded, and by 1890 the majority of patients left only in coffins. Old techniques returned - straitjackets, seclusion and sedative drugs such as bromides were used on unruly patients.

Controversies and legacies

In the first half of the 1900s asylums (or ‘mental hospitals’) became testing grounds for controversial treatments such as electroconvulsive therapy (ECT) and lobotomy. These methods helped some patients function again, but they irreparably harmed others. Such therapies became widely used because doctors and nurses wanted to offer patients cutting-edge treatment. ECT and lobotomy, however, reinforced an old and persistent image of asylums as intimidating places of last resort.

Many mental hospitals closed in the 1970s and 1980s. This was due to pressure from the antipsychiatry movement, feminist criticism, ex-patient activism and political suspicion of large, unaccountable institutions. Other mental hospitals were converted to ‘short-stay’ treatment centres - a policy enabled by new psychiatric drugs. In the UK this was called ‘care in the community’.

Many patients were left homeless. Others, especially people with profound intellectual disability or brain damage, remain institutionalised in ‘care homes’ their entire lives. Such patients and ex-patients depend on loved ones or charity to weather political and economic changes. People without such shelter are often forgotten. This distantly echoes the situation of people called ‘mad’ in the Middle Ages.